Colorectal cancer (CRC) is the second leading cause of cancer death among men and women in the United States; yet screening rates remain low. Individuals with limited literacy have been shown to be significantly less knowledgeable about CRC and CRC screening options, and report more barriers to CRC screening. Physician-patient discussions about CRC screening are far from optimal; although studies note patient willingness to consider CRC screening if recommended by their physician. Many interventions designed to increase CRC screening have targeted either physicians or patients, in relative isolation from the interactive context of physician-patient encounters and have had only limited success in improving screening rates. Combined strategies are needed to effectively increase patient knowledge and motivation, while supporting physician communication and recommendation of the behavior. We will implement both physician-only and combined physician-patient strategies within an Federally Qualified Health Center (FQHC) network to determine the most effective and efficient approach to promote CRC screening: Aim 1: Evaluate and compare the effectiveness of physician-only and combined patient- physician strategies on CRC screening rates. H1: Patients receiving the physician-only or combined patient-physician strategy will be more likely to receive a physician screening recommendation compared to those in usual care. H2: Patients receiving the physician-only or combined patient-physician strategy will be more likely to complete CRC screening compared to those in usual care. H3: Patients receiving the combined patient-physician strategy will be more likely to complete CRC screening compared to those receiving the physician-only strategy. H4: Limited literacy will be significantly associated with completion of CRC screening in usual care, but not in either the physician-only or combined physician-patient strategies. Aim 2: Conduct a cost-effectiveness study of the physician-only and combined patient- physician strategies within the FQHC setting. Aim 3: Conduct a process evaluation to determine patient, staff, physician, and system factors affecting the fidelity of both interventions. This study will be conducted among patients aged 50-79 receiving care within a system of FQHCs serving patients with varying levels of literacy. Results will directly inform translational strategie for cancer prevention within difficult community-based healthcare settings. PUBLIC HEALTH RELEVANCE: Health literacy has been identified as a significant variable in numerous areas of health care. Limited health literacy is associated with decreased use of preventive services, such as colorectal cancer (CRC) screening. The proposed study will assess the effectiveness of a combined physician and patient intervention, designed using a low-literacy approach, to promote CRC screening among patients receiving care in Federally Qualified Health Centers.